TY - JOUR A1 - Müller, Juliane A1 - Engel, Tilman A1 - Müller, Steffen A1 - Stoll, Josefine A1 - Baur, Heiner A1 - Mayer, Frank T1 - Effects of sudden walking perturbations on neuromuscular reflex activity and three-dimensional motion of the trunk in healthy controls and back pain symptomatic subjects JF - PLoS one N2 - Background Back pain patients (BPP) show delayed muscle onset, increased co-contractions, and variability as response to quasi-static sudden trunk loading in comparison to healthy controls (H). However, it is unclear whether these results can validly be transferred to suddenly applied walking perturbations, an automated but more functional and complex movement pattern. There is an evident need to develop research-based strategies for the rehabilitation of back pain. Therefore, the investigation of differences in trunk stability between H and BPP in functional movements is of primary interest in order to define suitable intervention regimes. The purpose of this study was to analyse neuromuscular reflex activity as well as three-dimensional trunk kinematics between H and BPP during walking perturbations. Methods Eighty H (31m/49f;29±9yrs;174±10cm;71±13kg) and 14 BPP (6m/8f;30±8yrs;171±10cm;67±14kg) walked (1m/s) on a split-belt treadmill while 15 right-sided perturbations (belt decelerating, 40m/s2, 50ms duration; 200ms after heel contact) were randomly applied. Trunk muscle activity was assessed using a 12-lead EMG set-up. Trunk kinematics were measured using a 3-segment-model consisting of 12 markers (upper thoracic (UTA), lower thoracic (LTA), lumbar area (LA)). EMG-RMS ([%],0-200ms after perturbation) was calculated and normalized to the RMS of unperturbed gait. Latency (TON;ms) and time to maximum activity (TMAX;ms) were analysed. Total motion amplitude (ROM;[°]) and mean angle (Amean;[°]) for extension-flexion, lateral flexion and rotation were calculated (whole stride cycle; 0-200ms after perturbation) for each of the three segments during unperturbed and perturbed gait. For ROM only, perturbed was normalized to unperturbed step [%] for the whole stride as well as the 200ms after perturbation. Data were analysed descriptively followed by a student´s t-test to account for group differences. Co-contraction was analyzed between ventral and dorsal muscles (V:R) as well as side right:side left ratio (Sright:Sleft). The coefficient of variation (CV;%) was calculated (EMG-RMS;ROM) to evaluate variability between the 15 perturbations for all groups. With respect to unequal distribution of participants to groups, an additional matched-group analysis was conducted. Fourteen healthy controls out of group H were sex-, age- and anthropometrically matched (group Hmatched) to the BPP. Results No group differences were observed for EMG-RMS or CV analysis (EMG/ROM) (p>0.025). Co-contraction analysis revealed no differences for V:R and Srigth:Sleft between the groups (p>0.025). BPP showed an increased TON and TMAX, being significant for Mm. rectus abdominus (p = 0.019) and erector spinae T9/L3 (p = 0.005/p = 0.015). ROM analysis over the unperturbed stride cycle revealed no differences between groups (p>0.025). Normalization of perturbed to unperturbed step lead to significant differences for the lumbar segment (LA) in lateral flexion with BPP showing higher normalized ROM compared to Hmatched (p = 0.02). BPP showed a significant higher flexed posture (UTA (p = 0.02); LTA (p = 0.004)) during normal walking (Amean). Trunk posture (Amean) during perturbation showed higher trunk extension values in LTA segments for H/Hmatched compared to BPP (p = 0.003). Matched group (BPP vs. Hmatched) analysis did not show any systematic changes of all results between groups. Conclusion BPP present impaired muscle response times and trunk posture, especially in the sagittal and transversal planes, compared to H. This could indicate reduced trunk stability and higher loading during gait perturbations. Y1 - 2017 U6 - https://doi.org/10.1371/journal.pone.0174034 SN - 1932-6203 VL - 12 IS - 3 PB - PLoS CY - Lawrence, Kan. ER - TY - JOUR A1 - Verch, Ronald A1 - Hirschmüller, Anja A1 - Müller, Juliane A1 - Baur, Heiner A1 - Mayer, Frank A1 - Müller, Steffen T1 - Is in-toing gait physiological in children? BT - Results of a large cohort study in 5910 healthy (pre-) school children JF - Gait & posture N2 - Research question: This study aimed to establish reference values in 1-14 year old healthy children and to implement FPA-percentile curves for daily clinical use. Methods: 5910 healthy children performed at least 3 repetitions of barefoot walking over an instrumented walkway using a pressure measurement platform. The FPA [degrees] was extracted and analyzed by age and gender (mean +/- standard deviation; median with percentiles, MANOVA (age, gender) and Wilcoxon-Signed-Rank test for intra-individual side differences (alpha = 0.05). Results: FPA maximum was observed in 2-year-old children and diminished significant until the age of 4 to moderate out-toeing. For ages 5-14, no statistically significant differences in FPA values were present (p > 0.05). MANOVA confirmed age (p < 0.001) and gender (p < 0.001) as significant FPA influencing factors, without combined effect (p > 0.05). In every age group, right feet showed significantly greater out-toeing (p < 0.05). Significance: Percentile values indicate a wide FPA range in children. FPA development in young children shows a spontaneous shift towards moderate external rotation (age 2-4), whereby in-toeing <= 1-5 degrees can be present, but can return to normal. Bilateral in-toeing after the age of four and unilateral in-toeing after the age of seven should be monitored. KW - Foot progression angle KW - Children KW - In-toeing KW - Out-toeing KW - Gait Y1 - 2018 U6 - https://doi.org/10.1016/j.gaitpost.2018.08.019 SN - 0966-6362 SN - 1879-2219 VL - 66 SP - 70 EP - 75 PB - Elsevier CY - Clare ER - TY - JOUR A1 - Müller, Steffen A1 - Carlsohn, Anja A1 - Müller, Juliane A1 - Baur, Heiner A1 - Mayer, Frank T1 - Static and dynamic foot characteristics in children aged 1-13 years a cross-sectional study JF - Gait & posture N2 - The aim of this study was to acquire static and dynamic foot geometry and loading in childhood, and to establish data for age groups of a population of 1-13 year old infants and children. A total of 10,382 children were recruited and 7788 children (48% males and 52% females) were finally included into the data analysis. For static foot geometry foot length and foot width were quantified in a standing position. Dynamic foot geometry and loading were assessed during walking on a walkway with self selected speed (Novel Emed X, 100 Hz, 4 sensors/cm(2)). Contact area (CA), peak pressure (PP), force time integral (FTI) and the arch index were calculated for the total, fore-, mid- and hindfoot. Results show that most static and dynamic foot characteristics change continuously during growth and maturation. Static foot length and width increased with age from 13.1 +/- 0.8 cm (length) and 5.7 +/- 0.4 cm (width) in the youngest to 24.4 +/- 1.5 cm (length) and 8.9 +/- 0.6 cm (width) in the oldest. A mean walking velocity of 0.94 +/- 0.25 m/s was observed. Arch-index ranged from 0.32 +/- 0.04 [a.u.] in the one-year old to 0.21 +/- 0.13 [a.u.] in the 5-year olds and remains constant afterwards. This study provides data for static and dynamic foot characteristics in children based on a cohort of 7788 subjects. Static and dynamic foot measures change differently during growth and maturation. Dynamic foot measurements provide additional information about the children's foot compared to static measures. KW - Children KW - Foot KW - Geometry KW - Arch-index KW - Plantar pressure Y1 - 2012 U6 - https://doi.org/10.1016/j.gaitpost.2011.10.357 SN - 0966-6362 VL - 35 IS - 3 SP - 389 EP - 394 PB - Elsevier CY - Clare ER - TY - JOUR A1 - Hirschmüller, Anja A1 - Baur, Heiner A1 - Müller, Steffen A1 - Helwig, Peter A1 - Dickhuth, Hans-Hermann A1 - Mayer, Frank T1 - Clinical effectiveness of customised sport shoe orthoses for overuse injuries in runners a randomised controlled study JF - British journal of sports medicine : the journal of sport and exercise medicine N2 - Background and objectives Treatment of chronic running-related overuse injuries by orthopaedic shoe orthoses is very common but not evidence-based to date. Hypothesis Polyurethane foam orthoses adapted to a participant's barefoot plantar pressure distribution are an effective treatment option for chronic overuse injuries in runners. Design Prospective, randomised, controlled clinical trial. Intervention 51 patients with running injuries were treated with custom-made, semirigid running shoe orthoses for 8 weeks. 48 served as a randomised control group that continued regular training activity without any treatment. Main outcome measures Evaluation was made by the validated pain questionnaire Subjective Pain Experience Scale, the pain disability index and a comfort index in the orthoses group (ICI). Results There were statistically significant differences between the orthoses and control groups at 8 weeks for the pain disability index (mean difference 3.2; 95% CI 0.9 to 5.5) and the Subjective Pain Experience Scale (6.6; 2.6 to 10.6). The patients with orthoses reported a rising wearing comfort (pre-treatment ICI 69/100; post-treatment ICI 83/100) that was most pronounced in the first 4 weeks (ICI 80.4/100). Conclusion Customised polyurethane running shoe orthoses are an effective conservative therapy strategy for chronic running injuries with high comfort and acceptance of injured runners. Y1 - 2011 U6 - https://doi.org/10.1136/bjsm.2008.055830 SN - 0306-3674 VL - 45 IS - 12 SP - 959 EP - 965 PB - BMJ Publ. Group CY - London ER - TY - JOUR A1 - Baur, Heiner A1 - Hirschmüller, Anja A1 - Müller, Steffen A1 - Cassel, Michael A1 - Mayer, Frank T1 - Is EMG of the lower leg dependent on weekly running mileage? JF - International journal of sports medicine N2 - Neuromuscular activity of the lower leg is dependent on the task performed, speed of movement and gender. Whether training volume influences neuromuscular activity is not known. The EMG of physically active persons differing in running mileage was analysed to investigate this. 55 volunteers were allocated to a low (LM: < 30 km), intermediate (IM: > 30 km & < 45 km) or high mileage (HM: > 45 km) group according to their weekly running volume. Neuromuscular activity of the lower leg was measured during running (3.33 m.s(-1)). Mean amplitude values for preactivation, weight acceptance and push-off were calculated and normalised to the mean activity of the entire gait cycle. Higher activity in the gastrocnemius group was observed in weight acceptance in LM compared to IM (+30%) and HM (+25%) but lower activity was present in the push-off for LM compared to IM and HM. For the peroneal muscle, differences were present in the push-off where HM showed increased activity compared to IM (+24%) and LM (+60%). The tibial muscle revealed slightly lower activity during preactivation for the high mileage runners. Neuromuscular activity differs during stance between the high and intermediate group compared to low mileage runners. Slight adaptations in neuromuscular activation indicate a more target-oriented activation strategy possibly due to repetitive training in runners with higher weekly mileage. KW - locomotion KW - neuromuscular control KW - running gait KW - training volume Y1 - 2012 U6 - https://doi.org/10.1055/s-0031-1286250 SN - 0172-4622 VL - 33 IS - 1 SP - 53 EP - 57 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Baur, Heiner A1 - Müller, Steffen A1 - Hirschmüller, Anja A1 - Cassel, Michael A1 - Weber, Josefine A1 - Mayer, Frank T1 - Comparison in lower leg neuromuscular activity between runners with unilateral mid-portion Achilles tendinopathy and healthy individuals JF - Journal of electromyography and kinesiology N2 - Neuromuscular control in functional situations and possible impairments due to Achilles tendinopathy are not well understood. Thirty controls (CO) and 30 runners with Achilles tendinopathy (AT) were tested on a treadmill at 3.33 m s(-1) (12 km h(-1)). Neuromuscular activity of the lower leg (tibialis anterior, peroneal, and gastrocnemius muscle) was measured by surface electromyography. Mean amplitude values (MAV) for the gait cycle phases preactivation, weight acceptance and push-off were calculated and normalised to the mean activity of the entire gait cycle. MAVs of the tibialis anterior did not differ between CO and AT in any gait cycle phase. The activation of the peroneal muscle was lower in AT in weight acceptance (p = 0.006), whereas no difference between CO and AT was found in preactivation (p = 0.71) and push-off (p = 0.83). Also, MAVs of the gastrocnemius muscle did not differ between AT and CO in preactivity (p = 0.71) but were reduced in AT during weight acceptance (p = 0.001) and push-off (p = 0.04). Achilles tendinopathy does not seem to alter pre-programmed neural control but might induce mechanical deficits of the lower extremity during weight bearing (joint stability). This should be addressed in the therapy process of AT. KW - Ankle joint KW - Electromyography KW - Overuse injury KW - Running gait Y1 - 2011 U6 - https://doi.org/10.1016/j.jelekin.2010.11.010 SN - 1050-6411 VL - 21 IS - 3 SP - 499 EP - 505 PB - Elsevier CY - Oxford ER - TY - JOUR A1 - Müller, Steffen A1 - Mayer, Patrizia A1 - Baur, Heiner A1 - Mayer, Frank T1 - Higher velocities in isokinetic dynamometry a pilot study of new test mode with active compensation of inertia JF - Isokinetics and exercise science : official journal of the European Isokinetic Society N2 - Isokinetic dynamometry is a standard technique for strength testing and training. Nevertheless reliability and validity is limited due to inertia effects, especially for high velocities. Therefore in a first methodological approach the purpose was to evaluate a new isokinetic measurement mode including inertia compensation compared to a classic isokinetic measurement mode for single and multijoint movements at different velocities. Isokinetic maximum strength measurements were carried out in 26 healthy active subjects. Tests were performed using classic isokinetic and new isokinetic mode in random order. Maximum torque/force, maximum movement velocity and time for acceleration were calculated. For inter-instrument agreement Bland and Altman analysis, systematic and random error was quantified. Differences between both methods were assessed (ANOVA alpha = 0.05). Bland and Altman analysis showed the highest agreement between the two modes for strength and velocity measurements (bias: < +/- 1.1%; LOA: < 14.2%) in knee flexion/extension at slow isokinetic velocity (60 degrees/s). Least agreement (range: bias: -67.6% +/- 119.0%; LOA: 53.4% 69.3%) was observed for shoulder/arm test at high isokinetic velocity (360 degrees/s). The Isokin(new) mode showed higher maximum movement velocities (p < 0.05). For low isokinetic velocities the new mode agrees with the classic mode. Especially at high isokinetic velocities the new isokinetic mode shows relevant benefits coupled with a possible trade-off with the force/torque measurement. In conclusion, this study offers for the first time a comparison between the 'classical' and inertia-compensated isokinetic dynamometers indicating the advantages and disadvantages associated with each individual approach, particularly as they relate to medium or high velocities in testing and training. KW - Strength testing KW - concentric KW - validity KW - trunk KW - knee KW - shoulder Y1 - 2011 U6 - https://doi.org/10.3233/IES-2011-0398 SN - 0959-3020 VL - 19 IS - 2 SP - 63 EP - 70 PB - IOS Press CY - Amsterdam ER - TY - JOUR A1 - Wahmkow, Gunnar A1 - Cassel, Michael A1 - Mayer, Frank A1 - Baur, Heiner T1 - Effects of different medial arch support heights on rearfoot kinematics JF - PLoS one N2 - Background Foot orthoses are usually assumed to be effective by optimizing mechanically dynamic rearfoot configuration. However, the effect from a foot orthosis on kinematics that has been demonstrated scientifically has only been marginal. The aim of this study was to examine the effect of different heights in medial arch-supported foot orthoses on rear foot motion during gait. Methods Nineteen asymptomatic runners (36±11years, 180±5cm, 79±10kg; 41±22km/week) participated in the study. Trials were recorded at 3.1 mph (5 km/h) on a treadmill. Athletes walked barefoot and with 4 different not customized medial arch-supported foot orthoses of various arch heights (N:0 mm, M:30 mm, H:35 mm, E:40mm). Six infrared cameras and the `Oxford Foot Model´ were used to capture motion. The average stride in each condition was calculated from 50 gait cycles per condition. Eversion excursion and internal tibia rotation were analyzed. Descriptive statistics included calculating the mean ± SD and 95% CIs. Group differences by condition were analyzed by one factor (foot orthoses) repeated measures ANOVA (α = 0.05). Results Eversion excursion revealed the lowest values for N and highest for H (B:4.6°±2.2°; 95% CI [3.1;6.2]/N:4.0°±1.7°; [2.9;5.2]/M:5.2°±2.6°; [3.6;6.8]/H:6.2°±3.3°; [4.0;8.5]/E:5.1°±3.5°; [2.8;7.5]) (p>0.05). Range of internal tibia rotation was lowest with orthosis H and highest with E (B:13.3°±3.2°; 95% CI [11.0;15.6]/N:14.5°±7.2°; [9.2;19.6]/M:13.8°±5.0°; [10.8;16.8]/H:12.3°±4.3°; [9.0;15.6]/E:14.9°±5.0°; [11.5;18.3]) (p>0.05). Differences between conditions were small and the intrasubject variation high. Conclusion Our results indicate that different arch support heights have no systematic effect on eversion excursion or the range of internal tibia rotation and therefore might not exert a crucial influence on rear foot alignment during gait. Y1 - 2017 U6 - https://doi.org/10.1371/journal.pone.0172334 SN - 1932-6203 VL - 12 IS - 3 PB - PLoS CY - Lawrence, Kan. ER - TY - JOUR A1 - Cassel, Michael A1 - Baur, Heiner A1 - Hirschmueller, Anja A1 - Carlsohn, Anja A1 - Fröhlich, Katja A1 - Mayer, Frank T1 - Prevalence of Achilles and patellar tendinopathy and their association to intratendinous changes in adolescent athletes JF - Scandinavian journal of medicine & science in sports N2 - Achilles (AT) and patellar tendons (PT) are commonly affected by tendinopathy in adult athletes but prevalence of symptoms and morphological changes in adolescents is unclear. The study aimed to determine prevalence of tendinopathy and intratendinous changes in ATs and PTs of adolescent athletes. A total of 760 adolescent athletes (13.0 +/- 1.9 years; 160 +/- 13cm; 50 +/- 14kg) were examined. History, local clinical examination, and longitudinal Doppler ultrasound analysis for both ATs and PTs were performed including identification of intratendinous echoic changes and vascularization. Diagnosis of tendinopathy was complied clinically in case of positive history of tendon pain and tendon pain on palpation. Achilles tendinopathy was diagnosed in 1.8% and patellar tendinopathy in 5.8%. Vascularizations were visible in 3.0% of ATs and 11.4% of PTs, hypoechogenicities in 0.7% and 3.2% as well as hyperechogenicities in 0% and 0.3%, respectively. Vascularizations and hypoechogenicities were statistically significantly more often in males than in females (P0.02). Subjects with patellar tendinopathy had higher prevalence of structural intratendinous changes than those without PT symptoms (P0.001). In adolescent athletes, patellar tendinopathy is three times more frequent compared with Achilles tendinopathy. Longitudinal studies are necessary to investigate physiological or pathological origin of vascularizations and its predictive value in development of tendinopathy. KW - Prevalence KW - tendinopathy KW - sonography KW - Doppler ultrasound KW - vascularization KW - hypoechogenicities KW - hyperechogenicities KW - adolescent athletes Y1 - 2015 U6 - https://doi.org/10.1111/sms.12318 SN - 0905-7188 SN - 1600-0838 VL - 25 IS - 3 SP - e310 EP - e318 PB - Wiley-Blackwell CY - Hoboken ER - TY - JOUR A1 - Mueller, Steffen A1 - Carlsohn, Anja A1 - Mueller, Juliane A1 - Baur, Heiner A1 - Mayer, Frank T1 - Influence of Obesity on Foot Loading Characteristics in Gait for Children Aged 1 to 12 Years JF - PLoS one N2 - Background Overweight and obesity are increasing health problems that are not restricted to adults only. Childhood obesity is associated with metabolic, psychological and musculoskeletal comorbidities. However, knowledge about the effect of obesity on the foot function across maturation is lacking. Decreased foot function with disproportional loading characteristics is expected for obese children. The aim of this study was to examine foot loading characteristics during gait of normal-weight, overweight and obese children aged 1-12 years. Methods Results Mean walking velocity was 0.95 +/- 0.25 m/s with no differences between normal-weight, overweight or obese children (p = 0.0841). Results show higher foot contact area, arch index, peak pressure and force time integral in overweight and obese children (p< 0.001). Obese children showed the 1.48-fold (1 year-old) to 3.49-fold (10 year-old) midfoot loading (FTI) compared to normal-weight. Conclusion Additional body mass leads to higher overall load, with disproportional impact on the midfoot area and longitudinal foot arch showing characteristic foot loading patterns. Already the feet of one and two year old children are significantly affected. Childhood overweight and obesity is not compensated by the musculoskeletal system. To avoid excessive foot loading with potential risk of discomfort or pain in childhood, prevention strategies should be developed and validated for children with a high body mass index and functional changes in the midfoot area. The presented plantar pressure values could additionally serve as reference data to identify suspicious foot loading patterns in children. Y1 - 2016 U6 - https://doi.org/10.1371/journal.pone.0149924 SN - 1932-6203 VL - 11 SP - 1710 EP - 1717 PB - PLoS CY - San Fransisco ER -